Distal tibial plating system

ABSTRACT

Systems for treating bone fractures are disclosed. Exemplary systems may include a backpack and one or more bone plates for engaging bone members. The backpack may be configured to be temporarily attached to the bone plate in order to provide trajectories for fasteners received by the bone plate. The bone plates can receive one or more screws to secure the bone plates to an underlying bone member. The one or more screws can be inserted into bone plate holes that can be considered locking or non-locking. The bone plates described herein can have particular combinations of locking and/or non-locking holes. Additional bone plate holes can be used to accept sutures, K-wire, or other instrumentation.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation-in-part of U.S. applicationSer. No. 15/910,041 filed on Mar. 2, 2018, which is hereby incorporatedby reference in its entirety.

FIELD OF THE INVENTION

The present disclosure relates to surgical devices, systems, andmethods, and more particularly, stabilization systems including plates,for example, for trauma applications.

BACKGROUND OF THE INVENTION

Bone fractures can be healed using plating systems. During treatment,one or more screws are placed on either side of a fracture, therebycausing compression and healing of the fracture. There is a need forimproved plating systems as well as mechanisms for accurate use of theplating systems.

SUMMARY OF THE INVENTION

This Summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This Summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used to limit the scope of the claimed subject matter.

In accordance with the application, a system for treating a fracture ina bone is provided. In some embodiments, the system comprises a backpackand a bone plate configured to engage the bone. The bone plate includesan inferior end having a base portion extending along a first axis. Thebase portion comprises a first row of holes and a second row of holesfor receiving one or more fasteners therein. A superior end has a shaftportion connected to the base portion. The shaft portion extends along asecond axis, different from the first axis and comprises at least oneadditional hole for receiving a fastener therein. At least one fasteneris received in the base portion and is positioned in the first row ofholes or second row of holes. At least one additional fastener is alsoreceived in the shaft portion and is positioned in the at least oneadditional hole. Further, the backpack may be configured to betemporarily attached to the base portion and configured to provide atrajectory of insertion for the at least one fastener received in thebase portion.

In other embodiments, the system comprises a backpack and a bone plateconfigured to engage the bone. The bone plate comprises an inferior endhaving a base portion. The base portion has a first type of hole formedtherethrough and a second type of hole formed therethrough. A superiorend has a shaft portion. The shaft portion has a third type of holeformed therethrough and a fourth type of hole formed therethrough. Atleast one fastener is received in the base portion and positioned in thefirst type of hole, wherein the at least one fastener is non-threaded.At least one additional fastener is received in the shaft portion andpositioned in the third type of hole. Further, the backpack may beconfigured to be temporarily attached to the base portion and configuredto provide a trajectory of insertion for the at least one fastenerreceived in the base portion.

In still other embodiments, the system comprises a bone plate configuredto engage the bone. The bone plate comprises an inferior end having abase portion. The base portion has a first plurality of holes formedtherethrough. A superior end has a shaft portion. The shaft portion hasa second plurality of holes formed therethrough. The shaft portion alsohas an undercut contact surface and a plurality of side relief cutsformed therein between adjacent holes of the second plurality of holes.At least one fastener is received in the base portion and is positionedone of the first plurality of holes. At least one additional fastener isreceived in the shaft portion and positioned in one of the secondplurality of holes. Further, the backpack may be configured to betemporarily attached to the base portion and configured to provide atrajectory of insertion for the at least one fastener received in thebase portion.

Also provided are stabilization systems, methods for installing thestabilization systems, and kits including bone plates, fasteners, andcomponents and instruments for installing the same.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention, and theattendant advantages and features thereof, will be more readilyunderstood by reference to the following detailed description whenconsidered in conjunction with the accompanying drawings, wherein:

FIG. 1 is a side elevational view of a bone plate assembly in accordancewith some embodiments attached to a tibia.

FIG. 2 is a sectional view of an inferior end of a tibia and fibula.

FIG. 2A perspective view of a tibia and fibula and associated ligaments.

FIG. 3 is a side perspective view of the bone plate of FIG. 1.

FIG. 4 is a front elevational view of the bone plate of FIG. 1.

FIG. 5 is an enlarged front elevational view of an inferior end of thebone plate of FIG. 3.

FIG. 6 is a perspective view of the inferior end of the bone plate ofFIG. 3 with a plurality of screws inserted therethrough.

FIG. 7 is a sectional view of tibia with the bone plate of FIG. 1attached thereto.

FIG. 8 is a perspective view of the inferior end of the bone plate ofFIG. 3 with a K-wire inserted therethrough.

FIG. 9 is an enlarged top plan view of a portion of the superior end ofthe bone plate of FIG. 1 showing a dynamic compression plating (“DCP”)slot.

FIG. 10 is a sectional view of a bone with a screw inserted thereintothrough the DCP slot of FIG. 9.

FIG. 11 is an enlarged rear perspective view of a portion of thesuperior end of the bone plate of FIG. 1.

FIG. 12 is an enlarged front elevational view of a portion of thesuperior end of the bone plate of FIG. 1 showing a K-wire slot.

FIG. 13 is a top perspective view of an alternative bone plate inaccordance with some embodiments.

FIG. 14 is a top perspective view of a locking bone plate through holein accordance with some embodiments.

FIG. 15 is a top perspective view of a polyaxial bone plate through holein accordance with some embodiments.

FIG. 16 is a front perspective view of an alternative bone plateassembly in accordance with some embodiments attached to a tibia.

FIG. 17 is a front elevational view of the bone plate assembly of FIG.16.

FIG. 18 is a sectional view of the inferior portion of the tibia of FIG.16, showing screws from the bone plate assembly of FIG. 17.

FIG. 19 us a side elevational view of the bone plate assembly and tibiaof FIG. 16.

FIG. 20 is a rear elevational view of the base portion of the bone plateassembly of FIG. 16.

FIG. 21 is a side elevational view of the bone plate assembly of FIG.16.

FIG. 22 is a sectional view of a bone with a screw inserted thereintothrough a DCP slot in the bone plate of FIG. 16.

FIG. 23 is an enlarged rear perspective view of a portion of thesuperior end of the bone plate of FIG. 16.

FIG. 24 is a front elevational view of a portion of the superior end ofthe bone plate of FIG. 16 showing a K-wire slot.

FIG. 25 is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 26 is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 27 front elevational view of an alternative bone plate assembly inaccordance with some embodiments attached to a tibia.

FIG. 28 is a side elevational view of the bone assembly and tibia,partially in section, of FIG. 27.

FIG. 29 is a front elevational view of the bone plate assembly of FIG.27.

FIG. 30 is a side elevational view of the bone plate assembly of FIG.29.

FIG. 31 is an enlarged rear perspective view of a portion of thesuperior end of the bone plate of FIG. 29.

FIG. 32 is a sectional view of a bone with a screw inserted thereintothrough a DCP slot in the bone plate of FIG. 27.

FIG. 33 is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 34 is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 34A is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 34B is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 34C is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 34D is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 35 is a sectional view of a bone with a screw inserted thereintothrough a DCP slot in the bone plate of FIG. 34.

FIG. 36 is an enlarged front elevational view of is a portion of theinferior end of the bone plate of FIG. 34.

FIG. 37 is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 38 is a side elevational view of the bone plate of FIG. 37.

FIG. 39 is a front elevational view of an alternative bone plate inaccordance with some embodiments.

FIG. 40 is a front perspective view of the bone plate of FIG. 39attached to a tibia.

FIG. 41A illustrates an exemplary drill sleeve consistent with theprinciples of the present disclosure.

FIG. 41B illustrates an exemplary drill bit consistent with theprinciples of the present disclosure.

FIG. 42 illustrates an exemplary system for treating bone fracturesconsistent with the principles of the present disclosure, including abackpack and a bone plate.

FIG. 43 illustrates and exemplary backpack consistent with theprinciples of the present disclosure.

FIG. 44 illustrates an exemplary backpack attached to an implantconsistent with the principles of the present disclosure.

FIGS. 45A-45B illustrate an exemplary backpack consistent with theprinciples of the present disclosure.

FIGS. 46A-46C illustrate exemplary systems for treating bone fracturesconsistent with the principles of the present disclosure.

DETAILED DESCRIPTION OF THE INVENTION

In the drawings, like numerals indicate like elements throughout.Certain terminology is used herein for convenience only and is not to betaken as a limitation on the present invention. The terminology includesthe words specifically mentioned, derivatives thereof and words ofsimilar import. As used herein, the term “superior” is defined as adirection toward an upper portion of a patient and “inferior” is definedas a direction toward a lower portion of the patient.

The embodiments illustrated below are not intended to be exhaustive orto limit the invention to the precise form disclosed. These embodimentsare chosen and described to best explain the principle of the inventionand its application and practical use and to enable others skilled inthe art to best utilize the invention.

Reference herein to “one embodiment” or “an embodiment” means that aparticular feature, structure, or characteristic described in connectionwith the embodiment can be included in at least one embodiment of theinvention. The appearances of the phrase “in one embodiment” in variousplaces in the specification are not necessarily all referring to thesame embodiment, nor are separate or alternative embodiments necessarilymutually exclusive of other embodiments. The same applies to the term“implementation.”

As used in this application, the word “exemplary” is used herein to meanserving as an example, instance, or illustration. Any aspect or designdescribed herein as “exemplary” is not necessarily to be construed aspreferred or advantageous over other aspects or designs. Rather, use ofthe word exemplary is intended to present concepts in a concretefashion.

Additionally, the term “or” is intended to mean an inclusive “or” ratherthan an exclusive “or”. That is, unless specified otherwise, or clearfrom context, “X employs A or B” is intended to mean any of the naturalinclusive permutations. That is, if X employs A; X employs B; or Xemploys both A and B, then “X employs A or B” is satisfied under any ofthe foregoing instances. In addition, the articles “a” and “an” as usedin this application and the appended claims should generally beconstrued to mean “one or more” unless specified otherwise or clear fromcontext to be directed to a singular form.

Unless explicitly stated otherwise, each numerical value and rangeshould be interpreted as being approximate as if the word “about” or“approximately” preceded the value of the value or range.

The use of figure numbers and/or figure reference labels in the claimsis intended to identify one or more possible embodiments of the claimedsubject matter in order to facilitate the interpretation of the claims.Such use is not to be construed as necessarily limiting the scope ofthose claims to the embodiments shown in the corresponding figures.

Embodiments of the present application are generally directed todevices, systems and methods for bone stabilization. In particular,embodiments are directed to bone plates that extend across bone membersto treat one or more fractures.

The plates described herein may be adapted to contact one or more bones.For example, the plates may fit one more long bones, such as a femur, adistal tibia, a proximal tibia, a proximal humerus, a distal humerus, aclavicle, a fibula, an ulna, a radius, bones of the foot, bones of thehand, or other suitable bone or bones. The bone plates may be curved,contoured, straight, or flat. The plates may have a base portion that iscontoured to match a particular bone surface, such as a metaphysis ordiaphysis, flares out from the shaft portion, forms an L-shape, T-shape,Y-shape, etc., with the shaft portion, or that forms any otherappropriate shape to fit the anatomy of the bone to be treated. Theplates may be adapted to secure small or large bone fragments, single ormultiple bone fragments, or otherwise secure one or more fractures. Inparticular, the systems may include a series of trauma plates and screwsdesigned for the fixation of fractures and fragments in diaphyseal andmetaphyseal bone. Different bone plates may be used to treat varioustypes and locations of fractures.

The bone plates can be comprised of titanium, stainless steel, cobaltchrome, carbon composite, plastic or polymer—such aspolyetheretherketone (PEEK), polyethylene, ultra high molecular weightpolyethylene (UBMWPE), resorbable polylactic acid (PLA), polyglycolicacid (PGA), combinations or alloys of such materials or any otherappropriate material that has sufficient strength to be secured to andhold bone, while also having sufficient biocompatibility to be implantedinto a body. Similarly, the bone plates may receive one or more screwsor fasteners may be comprised of titanium, cobalt chrome,cobalt-chrome-molybdenum, stainless steel, tungsten carbide,combinations or alloys of such materials or other appropriatebiocompatible materials. Although the above list of materials includesmany typical materials out of which bone plates and fasteners are made,it should be understood that bone plates and fasteners comprised of anyappropriate material are contemplated.

The bone plates described herein can be considered “locking” or“non-locking” plates. Locking plates include one or more openings foraccepting one or more locking fasteners. The one or more openings can bepartially or fully threaded. In some embodiments, these openings includefully threaded or stacked openings, which accept both locking andnon-locking fasteners. In some embodiments, the locking fastenersinclude heads that are at least partially threaded. The lockingfasteners can be monoaxial or polyaxial. One non-limiting example of alocking fastener (among others) is shown in FIG. 6 of U.S. Pat. No.15/405,368, filed Jan. 13, 2017, which is hereby incorporated byreference in its entirety for all purposes.

Non-locking plates may include one or more openings for accepting one ormore non-locking fasteners. The one or more openings at least in partare non-threaded. In some embodiments, these openings includenon-threaded or stacked openings, which accept both locking andnon-locking fasteners. In some embodiments, the non-locking fastenersinclude heads that are non-threaded. The non-locking fasteners can bemonoaxial or polyaxial. One non-limiting example of a non-lockingfastener (among others) is shown in FIG. 4 of U.S. 15/405,368, filedJan. 13, 2017, which is hereby incorporated by reference in its entiretyfor all purposes. In some embodiments, the non-locking fasteners caninclude dynamic compression screws, which enable dynamic compression ofan underlying bone.

Below are various examples of locking and non-locking plates attachableto bone. In some embodiments, locking plates may be thicker thannon-locking plates. Locking plates may be useful for patients that haveweaker bone, while non-locking plates may be useful for patients thathave strong bone.

The locking and non-locking plates described below can be attached todifferent bones to treat fractures. In particular, the locking andnon-locking plates can be used to treat fractures of the tibia, althoughone skilled in the art will appreciate that the novel plates describedherein can be applied to fractures on other types of bone as well.Implants with anatomic shapes suitable for fixation at distinct regionsof the tibia include anterolateral plates, medial plates, posteriorT-plates, metaphyseal plates, anterior plates, and posterolateralplates. In other words, the plates can be attached to the above recitedaspects of a tibia. One skilled in the art will appreciate, however,that the plates are not limited to their specific locations on thetibia, and that a surgeon may choose to, for example, apply a lateralplate distally or a distal plate laterally, if desired, and according tothe anatomy of a particular patient.

FIGS. 1 and 3-15 disclose an anterolateral bone plate system 100(“system 100”) in accordance with a first embodiment. Referring to FIGS.1-2A, system 100 is attached to a tibia 50 and is contoured to fit alongthe anterior-lateral portion of the tibia 50 along the syndesmosis 52and the interosseous ligament 54 and extend onto the anterior portion ofthe tibia 50 (FIG. 1). The syndesmosis is a ligamentous attachmentbetween the fibula 56 and the tibia 50 (See FIGS. 2 and 2A). Ananterolateral bone plate 102 of system 100 is specific to the left andright tibia.

Referring to FIGS. 3 and 4, the bone plate 102 has a plurality ofthrough holes formed therein for receiving fasteners, wherein at leastsome of the fasteners received therein are locking fasteners. The boneplate 102 comprises an inferior end 104 having a base portion 106 and asuperior end 108 having a shaft portion 110. The bone plate 102 ismulti-planar, with the shaft portion 110 extending generally in asingular plane, while the base portion 106 is curved away from the planeand extends across more than one plane. The curvature of the baseportion 106 relative to the shaft portion 110 can be adjusted to matchthe anatomy of a particular patient.

The base portion 106 extends along a first longitudinal axis L1. In someembodiments, the inferior end 104 is chamfered around its perimeter.Advantageously, the contour and chamfer of the inferior end 104 helps toposition the bone plate 102 to minimize soft tissue irritation. In someembodiments, the base portion 106 will be placed on a bone member (e.g.,tibia) near an articular surface. Certain features of the base portion106 are advantageously designed to prevent or resist subsidence of anarticular surface.

In an exemplary embodiment, as shown in FIGS. 5 and 6, the base portion106 features two (2) rows of three (3) 2.5 mm polyaxial screw holes 120,121. These holes 120, 121 are through holes for receiving rafting screws122 that are closest to an articular surface of a joint. The purpose ofthese screws 122 is to capture articular fragments and provide a raftingconstruct. The nominal screw trajectories are parallel to the tibialplafond (joint surface) and support the articular fragments to maintaintheir alignment and rotation relative to the shaft of the tibia 50, asshown in FIG. 7.

By providing two sets of holes 120, 121, the bone plate 102advantageously accommodates a greater number of rafting screws 122,thereby providing greater support near the joint. In some embodiments,the first row of holes 120 are offset from the second row of holes 121,while in other embodiments, the first row of holes 120 are aligned withthe second row of holes 121. In some embodiments, the first row of holes120 can have the same number of holes as the second row of holes 121,while in other embodiments, the first row of holes 120 can have adifferent number of holes than the second row of holes 121. In thepresent embodiment, the bone plate 102 includes three (3) holes 120 andthree (3) holes 121.

As shown in FIGS. 3 and 5, the most inferior edge of the base portion106 further comprises one or more novel multi-purpose holes 124. Themulti-purpose holes 124 are smaller than the holes 120, 121. In someembodiments, the multi-purpose holes 124 enable passage ofsuture/needles to serve as anchor points useful for reattachment andrepositioning of soft tissue damaged during surgery. This may aidpost-surgical soft tissue healing. The multi-purpose holes 124 alsoallow for a non-threaded 1.6 mm K-wire 60 to be provisionally placed, asshown in FIG. 8. As shown in FIG. 8, one or more undercuts 126advantageously allow access to one or more sutures through the boneplate 102 even after the bone plate 102 is implanted on bone. Thesutures can be used to attach the bone plate 102 to adjacent tissue,thereby further securing the bone plate 102 at or near a surgical site.

Additionally, referring to FIG. 6, the plate 102 features a singlekickstand screw 130 that is angled towards the tip of the most medialscrew 132. The purpose of the kickstand screw 130 is to provideadditional stability of the articular fragments and aid in axial loadingof the tibia 50.

Referring back to FIGS. 3 and 4, the shaft portion 110 is connected tothe base portion 106. The shaft portion 110 extends along a second axisL2, different from the first axis L1. A plurality of polyaxial throughholes 140 extend along the length of the shaft portion 110 and acceptlocking and non-locking screws, both inserted within a cone ofangulation. At least four (4) holes 140 are provided and are sized toaccept 3.5 mm screws.

The most superior portion of the shaft portion 110 further comprises atapered tip 111. In some embodiments, the tapered tip 111 serves as aninsertion tip that allows the plate 102 to be inserted beneath skin to asurgical site. The bone plate 102 can be positioned adjacent to bone(e.g., a tibia), whereby the plate 102 can be fixed to the bone. In someembodiments, the tapered tip 111 allows for simplified submuscular plateinsertion to minimize incision length.

As shown in FIGS. 9 and 10, a dynamic compression plating (“DCP”) slot142 allows lateral motion of the plate 102 relative to the bone tocompress a bone fracture. 3.5 mm non-locking screws 143 are used forthis technique as well as standard neutral placement in the center ofthe slot 142. The DCP slot 142 is a through hole that also enablesoff-axis, or oblique, screw trajectories in the plane of the slot using3.5 mm non-locking screws 143, as shown in FIG. 10. Alternatively, 4.0mm cancellous screws enable oblique or neutral screw trajectoriesthrough the DCP slot 142, which can be useful for fragment capture orload neutralization across the fracture line. In some embodiments, theDCP slot 142 has a length that is greater than a length of any of theother holes 120, 121, 140 that receive bone screws therein. In someembodiments, the DCP slot 142 has a length that is at least twice thelength of a length of any of the other holes 120, 121, 140 that receivebone screws therein.

K-wire through holes 144 are placed along the length of the plate 102,typically on either side of a through hole 140, to provide provisionalfixation. The holes 144 allow for a 1.6 mm K-wire to be placedprovisionally.

Referring to FIG. 11, cylindrical undercuts 150 are formed on the rearsurface 103 of the plate 102 between adjacent screw holes 140 to helpreduce the moment of inertia between adjacent screw holes 140 to allowpreferential bending between the holes 140, thereby helping to minimizedeformation of the screw holes 140. This feature is useful for contourcustomization of the plate 102. In some embodiments, the undercuts 150minimize impact to the periosteal blood supply.

Side relief cuts, or bending scallops 152, shown in FIGS. 4 and 12, areprovided in the sides of the plate 102 on either side of thelongitudinal axis L2 and are another means of reducing the moment ofinertia between screw holes 140 to allow preferential bending betweenthe screw holes 140, helping to minimize deformation of the screw holes140. The bending scallops 152 are present along the shaft portion 110where contour customization by bending the plate 102 is the most likelyto be desired.

While bone plate 102 is shown having two row of through holes 120, 121,those skilled in the art will recognize that a bone plate 102A, shown inFIG. 13, can include only a single row of through holes 120. Further, asshown in FIGS. 14 and 15, the through holes 120, 121, 140 in plates102/102A can be threaded (FIG. 14) to accept threaded locking fastenersor unthreaded (FIG. 15) to accept polyaxial screws. Additionally, thethrough holes 120, 121 can be 2.5 mm or 3.5 mm in diameter, while thethrough holes 140 are typically 3.5 mm in diameter, although othersuitable dimensions may be contemplated.

FIGS. 16-26 disclose a bone plate system 200 (“system 200”) inaccordance with a second embodiment. System 200 includes a medial boneplate 202 that is contoured to fit along the medial portion of the tibia50 (FIGS. 16 and 19). Bone plate 202 of system 200 is specific to theleft and right tibia. The medial distal tibia 50 is an area of littlesoft tissue coverage and is by far one of the most challenging areas totreat pilon fractures from. The thickness of the plate 202 is minimal toreduce soft tissue irritation and failure.

Referring to FIG. 17 the bone plate 202 has a plurality of through holesformed therein for receiving fasteners, wherein at least some of thefasteners received therein are locking fasteners. The bone plate 202comprises an inferior end 204 having a base portion 206 and a superiorend 208 having a shaft portion 210. The bone plate 202 has a curvatureas shown in FIG. 19, to accommodate the curvature of the inferior end ofthe tibia 50.

The body 202 extends along a longitudinal axis L3. In some embodiments,the inferior end 204 is chamfered around its perimeter. Advantageously,the contour and chamfer of the inferior end 204 helps to position thebone plate 202 to minimize soft tissue irritation. In some embodiments,the base portion 206 will be placed on a bone member (e.g., tibia) nearan articular surface. Certain features of the base portion 206 areadvantageously designed to prevent or resist subsidence of an articularsurface. The base portion 206 is the widest portion of the plate 202.

In an exemplary embodiment, as shown in FIG. 17, the base portion 206features a plurality of screw holes 220. The three (3) most inferiorscrew holes 220 accommodate polyaxial screws 222 and are oriented suchthat the screws 222 match the contour of the talar dome 58, also knownas the plafond. See FIG. 18.

The remaining distal screws 224 diverge from each other to increase theworking width of the plate 202, as shown in FIG. 20. This feature isbeneficial for capturing both anterior bone fragments as well asposterior fragments, providing support to the articular block.

Referring to FIG. 20, the two outer most superior screws 224 are angledin an inferior direction to provide additional support of the articularblock. The screws 224 also provide support for axial loading. In anexemplary embodiment, screw holes 220 are sized to accept 2.5 mm screws222, 224.

Referring to FIGS. 20 and 21, the first screw hole 240 on the shaftportion 210 of the plate 202 closest to the base portion 206 supports akickstand screw 226. The kickstand screw 226 crosses the fracture lineof the tibia 50 and helps connect the articular block to the shaft ofthe tibia 50. In an exemplary embodiment, the screw holes 240 are sizedto accept a 3.5 mm screw 226.

Referring back to FIG. 17, the shaft portion 210 is connected to thebase portion 206 along axis L3. A plurality of polyaxial through holes240 extend along the length of the shaft portion 210 and accept lockingand non-locking screws, both inserted within a cone of angulation. Atleast four holes 240 are provided and are sized to accept 3.5 mm screws.

The most superior portion of the shaft portion 210 further comprises atapered tip 211. In some embodiments, the tapered tip 211 serves as aninsertion tip that allows the plate 202 to be inserted beneath skin to asurgical site. The bone plate 202 can be positioned adjacent to bone(e.g., a tibia), whereby the plate 202 can be fixed to the bone. In someembodiments, the tapered tip 211 allows for simplified submuscular plateinsertion to minimize incision length.

As shown in FIGS. 17 and 22, a dynamic compression plating (“DCP”) slot242 allows lateral motion of the plate 202 relative to the bone tocompress a bone fracture. The DCP slot 242 is a through hole that alsoenables off-axis, or oblique, screw trajectories in the plane of theslot using 3.5 mm non-locking screws 243. Alternatively, 4.0 mmcancellous screws enable oblique or neutral screw trajectories throughthe DCP slot 242, which can be useful for fragment capture or loadneutralization across the fracture line. In some embodiments, the DCPslot 242 has a length that is greater than a length of any of the otherholes 220, 240 that receive bone screws therein. In some embodiments,the DCP slot 242 has a length that is at least twice the length of alength of any of the other holes 240, 242 that receive bone screwstherein.

K-wire through holes 244 are placed along the length of the plate 202,typically on either side of a through hole 240, to provide provisionalfixation. The holes 244 allow for a 1.6 mm K-wire to be placedprovisionally.

Referring to FIG. 23, cylindrical undercuts 250 are formed on the rearsurface 203 of the plate 202 between adjacent screw holes 240 to helpreduce the moment of inertia between adjacent screw holes 240 to allowpreferential bending between the holes 240, thereby helping to minimizedeformation of the screw holes 240. This feature is useful for contourcustomization of the plate 202. In some embodiments, the undercuts 250minimize impact to the periosteal blood supply.

Side relief cuts, or bending scallops 252, shown in FIG. 24, areprovided in the sides of the plate 202 on either side of thelongitudinal axis L3 and are another means of reducing the moment ofinertia between screw holes 240 to allow preferential bending betweenthe screw holes 240, helping to minimize deformation of the screw holes240. The bending scallops 252 are present along the shaft portion 210where contour customization by bending the plate 202 is the most likelyto be desired.

While FIG. 17 shows the plate 202 having four (4) through holes 240extending along the shaft portion 210, for larger patients, a plate202A, shown in FIG. 25, can be used. The plate 202A has a longer shaftportion 210A than the shaft portion 210, and includes eight throughholes 240, instead of the four (4) through holes 240 in the shaftportion 210. The shaft portion 210A also has a single DCP slot 242.

FIG. 26 shows an alternative plate 202B that includes a medial malleolustab 260 that extends inferiorly of the base portion 206. The medialmalleolus tab 260 includes a through hole 240 formed therein.

Similar to the through holes 120, 121, 140 in the plate 102 discussedabove, the through holes 220, 240 in the plate 202 can be threaded (seeFIG. 14) to accept threaded locking fasteners or unthreaded (see FIG.15) to accept polyaxial screws. Additionally, the through holes 220 canbe 2.5 mm or 3.5 mm in diameter, while the through holes 240 aretypically 3.5 mm in diameter.

FIGS. 27-33 disclose a bone plate system 300 (“system 300”) inaccordance with a third embodiment. System 300 includes a posterior boneplate 302 that is contoured to fit along the posterior portion of thetibia 50 (FIGS. 27 and 28). Bone plate 302 of system 300 isinterchangeable for left-leg and right-leg tibias 50.

Referring to FIGS. 29 and 30, the bone plate 302 has a plurality ofthrough holes formed therein for receiving fasteners, wherein at leastsome of the fasteners received therein are locking fasteners. The boneplate 302 comprises an inferior end 304 having a base portion 306 and asuperior end 308 having a shaft portion 310. As shown in FIG. 30, thebone plate 302 is multi-planar, with the most superior end of the shaftportion 310 extending generally in a singular plane, while the mostinferior end of the shaft portion 310 is curved away from the plane andextends across more than one plane. The curvature of the most inferiorend of the shaft portion 310 relative to the most superior end of theshaft portion 310 can be adjusted to match the anatomy of a particularpatient.

The base portion 306 extends along a first longitudinal axis L4. In someembodiments, the inferior end 304 is chamfered around its perimeter.Advantageously, the contour and chamfer of the inferior end 304 helps toposition the bone plate 302 to minimize soft tissue irritation. In someembodiments, the base portion 306 will be placed on a bone member (e.g.,tibia) near an articular surface. Certain features of the base portion306 are advantageously designed to prevent or resist subsidence of anarticular surface.

In an exemplary embodiment, as shown in FIG. 29, the base portion 306features a single row of four (4) 2.5 mm polyaxial screw holes 320.These holes 320 are through holes for receiving polyaxial screws 322that are mostly commonly placed uni-cortical (See FIG. 28). The functionof the screws 322 is to support the posterior malleolus fragments andprovide a secure block to which to fasten the anterior fragments.

As shown in FIG. 29, the most inferior edge of the base portion 306further comprises one or more novel multi-purpose holes 324. Themulti-purpose holes 324 are smaller than the holes 320. In someembodiments, the multi-purpose holes 324 enable passage ofsuture/needles to serve as anchor points useful for reattachment andrepositioning of soft tissue damaged during surgery. This may aidpost-surgical soft tissue healing. The multi-purpose holes 324 alsoallow for a non-threaded 1.6 mm K-wire (not shown) to be provisionallyplaced. As shown in FIG. 28, one or more undercuts 326 advantageouslyallow access to one or more sutures through the bone plate 302 evenafter the bone plate 302 is implanted on bone. The sutures can be usedto attach the bone plate 302 to adjacent tissue, thereby furthersecuring the bone plate 302 at or near a surgical site.

Referring back to FIGS. 29 and 30, the shaft portion 310 is connected tothe base portion 306. The shaft portion 310 extends along a second axisL5, extending generally orthogonally to the first axis L4. A pluralityof polyaxial through holes 340 extend along the length of the shaftportion 310 and accept locking and non-locking screws, both insertedwithin a cone of angulation. At least six holes 340 are provided and aresized to accept 3.5 mm screws 341. Additionally, referring to FIG. 30,the plate system 300 features two kickstand screws 330 that cross thefracture line and help connect the articular block to the shaft. Thekickstand screws 330 are located in the two most inferior holes 340 andare proximal to the base portion 306.

The most superior portion of the shaft portion 310 further comprises atapered tip 311. In some embodiments, the tapered tip 311 serves as aninsertion tip that allows the plate 302 to be inserted beneath skin to asurgical site. The bone plate 302 can be positioned adjacent to bone(e.g., a tibia), whereby the plate 302 can be fixed to the bone. In someembodiments, the tapered tip 311 allows for simplified submuscular plateinsertion to minimize incision length.

As shown in FIGS. 29 and 32, a DCP slot 342 allows lateral motion of theplate 302 relative to the bone to compress a bone fracture. 3.5 mmnon-locking screws 343 are used for this technique as well as standardneutral placement in the center of the slot 342. The DCP slot 342 is athrough hole that also enables off-axis, or oblique, screw trajectoriesin the plane of the slot using 3.5 mm non-locking screws 343, as shownin FIG. 32. Alternatively, 4.0 mm cancellous screws enable oblique orneutral screw trajectories through the DCP slot 342, which can be usefulfor fragment capture or load neutralization across the fracture line. Insome embodiments, the DCP slot 342 has a length that is greater than alength of any of the other holes 320, 340 that receive bone screwstherein. In some embodiments, the DCP slot 342 has a length that is atleast twice the length of a length of any of the other holes 320, 340that receive bone screws therein.

K-wire through holes 344 are placed along the length of the shaftportion 310, typically on either side of a through hole 340, to provideprovisional fixation. The holes 344 allow for a 1.6 mm K-wire to beplaced provisionally.

Referring to FIG. 31, cylindrical undercuts 350 are formed on the rearsurface 303 of the plate 302 between adjacent screw holes 340 to helpreduce the moment of inertia between adjacent screw holes 340 to allowpreferential bending between the holes 340, thereby helping to minimizedeformation of the screw holes 340. This feature is useful for contourcustomization of the plate 302. In some embodiments, the undercuts 350minimize impact to the periosteal blood supply.

Similar to the through holes 120, 121, 140 in the plate 102 discussedabove, the through holes 320, 340 in the plate 302 can be threaded (seeFIG. 14) to accept threaded locking fasteners or unthreaded (see FIG.15) to accept polyaxial screws. Additionally, the through holes 320 canbe 2.5 mm or 3.5 mm in diameter, while the through holes 340 aretypically 3.5 mm in diameter.

While FIG. 29 shows the plate 302 having three through holes 340extending along the shaft portion 210 superiorly of the DCP slot 342,for larger patients, a plate 302A, shown in FIG. 33, can be used. Theplate 302A has a longer shaft portion 310A than the shaft portion 310,and includes nine through holes 340, instead of the four (4) throughholes 340 in the shaft portion 310. The shaft portion 310A also has asingle DCP slot 342.

FIGS. 34-36 disclose a plurality of metaphyseal bone plates 402-402D inaccordance with a fourth embodiment. FIGS. 34-34D show differentembodiments of plates 402-402D with a common shaft portion 410, but withdifferent base portions 406-406D.

The plates 402-402D are small and thin in required locations,specifically in the base portion 406-406D of the plates 402-402D. Theplates 402-402D have a base portion 406-406D that has a smaller profilethan the shaft portion 410 of the plates 402-402D. A benefit of thesmall profile and thin stock in the base portions 406-406D is thereduced risk of soft tissue irritation and soft tissue failure. Thetheory behind the plates 402-402D is a design that blends the smallmini-fragment plates with the larger small fragment plates. The superiorportion 410 is slightly thicker and wider than the inferior base portion406, which provides the strength necessary to fix shaft fractures.

Referring to FIGS. 34-34D, the shaft portion 410 is connected to each ofthe different base portions 406-406D. The shaft portion 410 extendsalong a first axis L6. A plurality of polyaxial through holes 440 extendalong the length of the shaft portion 410 and accept locking andnon-locking screws, both inserted within a cone of angulation. At leasttwo holes 440 are provided and are sized to accept 3.5 mm screws.

The most superior portion of the shaft portion 410 further comprises atapered tip 411. In some embodiments, the tapered tip 411 serves as aninsertion tip that allows the plate 402-402D to be inserted beneath skinto a surgical site. The bone plate 402-402D can be positioned adjacentto bone (e.g., a tibia), whereby the plate 402-402D can be fixed to thebone. In some embodiments, the tapered tip 411 allows for simplifiedsubmuscular plate insertion to minimize incision length.

As shown in FIGS. 34 and 35, a dynamic compression plating (“DCP”) slot442 allows lateral motion of the plate 402 relative to the bone tocompress a bone fracture. 3.5 mm non-locking screws 443 are used forthis technique as well as standard neutral placement in the center ofthe slot 442. The DCP slot 442 is a through hole that also enablesoff-axis, or oblique, screw trajectories in the plane of the slot using3.5 mm non-locking screws 443, as shown in FIG. 35. Alternatively, 4.0mm cancellous screws enable oblique or neutral screw trajectoriesthrough the DCP slot 442, which can be useful for fragment capture orload neutralization across the fracture line. In some embodiments, theDCP slot 442 has a length that is greater than a length of any of theother holes 420, 440 that receive bone screws therein. In someembodiments, the DCP slot 442 has a length that is at least twice thelength of a length of any of the other holes 420, 440 that receive bonescrews therein.

K-wire through holes 444 are placed proximate to the tip 411 of theplate 402 as well as proximate to an interface between the shaft portion410 and the base portion 406-406D, to provide provisional fixation. Theholes 444 allow for a 1.6 mm K-wire to be placed provisionally.

Another design feature of the plates 402-402D is the ability to adjustand customize the contour of the base portion 410-410D to match anypatient's anatomy. Perimeter scallops 452 aid in bending the platewithout distorting the 2.5 mm polyaxial screw through holes 420. In anexemplary embodiment, the through holes 420 are spaced about 7.5 mmapart from adjacent through holes 420 which maximizes the amount offixation distally.

The plates 402-402D are designed with various shapes/profiles in thebase portion 406-406D to accommodate different implantation locations.Plate 402 is a linear plate, wherein the base portion 406 extends alongthe first axis L6 co-linearly with the shaft portion 410.

Plate 402A is a Y-plate, with a first leg 460 extending along a secondaxis L7, different from the first axis L6, and a second leg 462extending along a third axis L8, different from the first axis L6,wherein each of the axes L7 and L8 each extend at an angle of about 30degrees relative to the axis L6.

Plate 402B is also a Y-plate, with a first leg 460B extending along asecond axis L9, different from the first axis L6, and a second leg 462Bextending along a third axis L8, different from the first axis L6,wherein each of the axes L7 and L8 each extend at an angle of about 320degrees relative to the axis L6.

Plate 402C is a T-plate, with a first leg 460C extending along a secondaxis L10, generally orthogonal to the first axis L6. Plate 402D is aclover plate, with a plurality of 2.5 mm polyaxial screw through holes420 surrounding a central 2.5 mm polyaxial screw through hole 420.

Each plate 402-402D is optimal for different scenarios. For example,plates 402A, 402B are the perfect shape for the medial distal tibia. Thetwo legs 460B, 462B and 460C, 462C of the Y can be bent to fit aroundthe medial malleolus.

FIGS. 37 and 38 disclose an anterior bone plate 502 in accordance with afifth embodiment. The plate 502 is designed to be placed anterior on thedistal tibia (See FIG. 38) and is similar to the metaphyseal plates402-402D discussed above in the sense that the plate 502 can be modifiedand customized to fit the anatomy of the anterior tibia. The anteriordistal tibia lacks soft tissue coverage, similar to the medial distaltibia. The anterior plate 502 is thin, much like the medial bone plate202 and the base portion 106 of the anterolateral plate 102.

The bone plate 502 comprises an inferior end 504 having a base portion506 and a superior end 508 having a shaft portion 510. The bone plate502 is generally planar, but can be contoured to match a particularpatient's anatomy.

The base portion 506 is generally triangular in shape. In someembodiments, the inferior end 504 is chamfered around its perimeter.Advantageously, the contour and chamfer of the inferior end 504 helps toposition the bone plate 502 to minimize soft tissue irritation. In someembodiments, the base portion 506 will be placed on a bone member (e.g.,tibia) near an articular surface. Certain features of the base portion506 are advantageously designed to prevent or resist subsidence of anarticular surface.

In an exemplary embodiment, as shown in FIG. 37, the base portion 506features two (2) rows of three (3) 3.5 mm screw holes 520, 521, each rowextending along a respective leg 560, 562. The holes 520, 521 arethrough holes for receiving screws that are closest to an articularsurface of a joint. The holes 520, 521 can be locking holes or polyaxialholes. The polyaxial holes accept locking and non-locking screws, bothinserted within a cone of angulation. Each leg 560, 562 extends at anangle of about 15 degrees relative to a shaft longitudinal axis L12.

A connecting portion 564 connects the inferior most ends of the legs560, 562 to each other. The connecting portion 564 includes a row offour (4) 2.5 mm polyaxial screw holes 524. A cavity 526 is providedbetween the legs 560, 562 and the connecting portion 564.

By providing three (3) sets of holes 520, 521, 524, the bone plate 502advantageously accommodates a greater number of screws, therebyproviding greater support near the joint.

The shaft portion 510 is connected to the base portion 506. The shaftportion 510 extends along the axis L12. A plurality of polyaxial throughholes 540 extend along the length of the shaft portion 510 and acceptlocking and non-locking screws, both inserted within a cone ofangulation. At least three (3) holes 540 are provided and are sized toaccept 3.5 mm screws.

The most superior portion of the shaft portion 510 further comprises atapered tip 511. In some embodiments, the tapered tip 511 serves as aninsertion tip that allows the plate 502 to be inserted beneath skin to asurgical site. The bone plate 502 can be positioned adjacent to bone(e.g., a tibia), whereby the plate 502 can be fixed to the bone. In someembodiments, the tapered tip 511 allows for simplified submuscular plateinsertion to minimize incision length.

FIGS. 39 and 40 disclose a posterolateral bone plate 602 in accordancewith a sixth embodiment. The plate 602 is designed to address aposterior fracture of the tibia 50, as shown in FIG. 40.

Referring to FIG. 39, the bone plate 602 comprises an inferior end 604having a base portion 606 and a superior end 608 having a shaft portion610. The base portion 606 extends along a first longitudinal axis L13.In some embodiments, the inferior end 604 is chamfered around itsperimeter. Advantageously, the contour and chamfer of the inferior end604 helps to position the bone plate 602 to minimize soft tissueirritation. In some embodiments, the base portion 606 will be placed ona bone member (e.g., tibia 50) near an articular surface. Certainfeatures of the base portion 606 are advantageously designed to preventor resist subsidence of an articular surface.

In an exemplary embodiment, as shown in FIG. 39, the base portion 306features a single row of three (3) 2.5 mm co-linear screw holes 620. Theholes 620 are through holes for receiving screws that are closest to anarticular surface of a joint. The holes 620 can be locking holes orpolyaxial holes. The polyaxial holes accept locking and non-lockingscrews, both inserted within a cone of angulation.

The most inferior edge of the base portion 606 further comprises one ormore novel multi-purpose holes 624. The multi-purpose holes 624 aresmaller than the holes 620. In some embodiments, the multi-purpose holes624 enable passage of suture/needles to serve as anchor points usefulfor reattachment and repositioning of soft tissue damaged duringsurgery. This may aid post-surgical soft tissue healing. Themulti-purpose holes 624 also allow for a non-threaded 1.6 mm K-wire tobe provisionally placed.

The shaft portion 610 is connected to the base portion 606. The shaftportion 610 extends along a second axis L14, different from the firstaxis L13. A plurality of polyaxial through holes 640 extend along thelength of the shaft portion 610 and accept locking and non-lockingscrews, both inserted within a cone of angulation. At least three (3)holes 640 are provided and are sized to accept 3.5 mm screws.

The most superior portion of the shaft portion 610 further comprises atapered tip 611. In some embodiments, the tapered tip 611 serves as aninsertion tip that allows the plate 602 to be inserted beneath skin to asurgical site. The bone plate 602 can be positioned adjacent to bone(e.g., a tibia), whereby the plate 602 can be fixed to the bone. In someembodiments, the tapered tip 611 allows for simplified submuscular plateinsertion to minimize incision length.

As shown in FIG. 39, a DCP slot 642 allows lateral motion of the plate102 relative to the bone to compress a bone fracture. 3.5 mm non-lockingscrews (not shown) are used for this technique as well as standardneutral placement in the center of the slot 642. The DCP slot 642 is athrough hole that also enables off-axis, or oblique, screw trajectoriesin the plane of the slot using 3.5 mm non-locking screws. Alternatively,4.0 mm cancellous screws enable oblique or neutral screw trajectoriesthrough the DCP slot 642, which can be useful for fragment capture orload neutralization across the fracture line. In some embodiments, theDCP slot 642 has a length that is greater than a length of any of theother holes 620, 640 that receive bone screws therein. In someembodiments, the DCP slot 642 has a length that is at least twice thelength of a length of any of the other holes 620, 640 that receive bonescrews therein.

A K-wire through hole 644 is located at the superior end of the shaftportion 608, proximate to the tip 611, to provide provisional fixation.The hole 644 allows for a 1.6 mm K-wire to be placed provisionally.

An inferior part 650 of shaft portion 610 connects the DCP slot 642 tothe base portion 606. Inferior part 650 is angled with respect to axisL13 by an angle β of about 22 degrees. Inferior part 650 includes aplurality of polyaxial through holes 652 extend along the length of theinferior part 650 and accept locking and non-locking screws, bothinserted within a cone of angulation. At least three (3) holes 652 areprovided and are sized to accept 2.5 mm screws. In the embodiment shownin FIG. 39, four (4) holes 652 are provided.

While some embodiments of plates 102-602 according to exemplaryembodiments are shown with screws, while other plates 102-602 are not,those skilled in the art will recognize that all screw holes x20, x21,x40, x42 can include suitable screws of the screws described herein.

In accordance with one embodiment, a method of treating or fixingfractures and/or non-unions of the distal tibia may include providingone or more of the trauma plates to the affected region and securing theplate thereto. In particular, the method for repairing a bone fractureor non-union may include providing a bone plate or kit of bone plateshaving different sizes, shapes, or configurations, selecting theappropriate bone plate, positioning the bone plate adjacent to theaffected area, and securing the bone plate to the bone or bone portions.

Turning now to FIGS. 41A-46C, one or more embodiments of targetingnominal trajectories of distal holes of the anterolateral, wideanterolateral and medial plates, such as those discussed above, areillustrated. Nominal trajectories may refer to pre-set trajectories forinserting bone screws into a bone that a user of a bone plate assemblymay use. As noted above, bone plates consistent with the presentdisclosure may be polyaxial holes which may provide a user withflexibility regarding the trajectory to insert bone screws into the boneplate. A guide block, commonly known as a backpack, may attach to animplant and target nominal trajectories to the extent that the userprefers to use a pre-set trajectory instead of independently setting atrajectory in the polyaxial hole of the bone plate without use of thebackpack. The backpack may be placed onto the implant and locked intoplace via an attachment screw.

FIGS. 41A-B illustrate an exemplary drill sleeve 4102 (FIG. 41A) anddrill bit 4104 (FIG. 41B) consistent with the principles of the presentdisclosure. Drill sleeve 4102 and drill bit 4104 may be used inconjunction with implants discussed above and a backpack 4202 as shownin FIG. 42.

FIG. 42 illustrates a system 4200 for treating bone fractures. System4200 may comprise backpack 4202, implant or bone plate 4204, as well asbone screws described in detail above. Drill sleeve 4102 may be placedin proximity to the implant so that drill bit 4104 may be used to drilla hole in a bony structure that will ultimately be used to attachimplant 4204 to the patient at the target area.

In order to provide a nominal trajectory for drill bit 4104, backpack4202 may attach to implant 4204. Backpack 4202 may have holes 4206 thatalign with polyaxial holes of implant 4204. In order to secure backpack4202 to implant 4204, a reverse collet mechanism may be used to engageand attach to implant 4204.

FIG. 43 illustrates backpack 4202 in greater detail, including a reversecollet 4302 and a fastener 4304. Backpack 4204 may be inserted intoimplant 4204 in an unlocked position. Once inside a polyaxial hole ofimplant 4204, a user may tighten fastener 4304 into a locked position.In the locked position, backpack 4204 is rigidly engaged in thepolyaxial hole of implant 4204. At this point, holes 4206 are alignedwith polyaxial holes in implant 4204 in order to provide a nominaltrajectory for a drill bit entering holes 4206 and ultimately intoimplant 4204 and the bone.

FIG. 44 illustrates a cross-sectional view of fastener 4304 disposedwithin backpack 4202. After backpack 4202 is attached to implant 4204,system 4200 may be moved to a target bony area of a patient. A drill maybe used to provide a trajectory through backpack 4202 and implant 4204into a bone of patient. In this regard, backpack 4202 may provide anominal trajectory into the bone for bone screws that attach implant4204 to the target bony area. Once the trajectories are drilled into thebone, screws may be inserted through backpack 4202 to implant 4204 intothe bone of the patient. Holes 4206 may be large enough to receive ascrew and have the screw pass completely through hole 4206 to implant4204. Once the user is finished inserting one or more bone screws toattach implant 4204, backpack 4204 may be unlocked and released fromimplant 4204 leaving just implant 4204 and screws attached to the bone.

FIGS. 45A-45B illustrate exemplary embodiments of backpack 4202consistent with principles of the present disclosure. Backpack 4202 maycomprise a standoff 4502 that may be configured to aid in lining upbackpack 4202 with implant 4204. Standoff 4502 may be partiallyspherical or tapered in order to rest inside a hole in implant 4202before fastener 4304 is disposed in backpack 4202 to attach implant 4204to backpack 4202.

FIGS. 46A-46C illustrate exemplary backpacks 4602, 4606, and 4610 andexemplary implants 4604, 4608, and 4612. For example, backpack 4602 maybe configured to be used in with an anterolateral plate 4604, backpack4606 may be configured to be used with a medial plate 4608, and backpack4610 may be configured to be used with a wide anterolateral plate 4612.

One skilled in the art will appreciate that the embodiments discussedabove are non-limiting. While bone plates may be described as suitablefor a particular approach (e.g., medial or posterior), one skilled inthe art will appreciate that the bone plates can be used for multipleapproaches. In addition, while bone plates are described as havingparticular holes (e.g., locking or non-locking), one skilled in the artwill appreciate that any of the bone plates can include locking,non-locking or a combination of locking and non-locking holes. Inaddition to the bone plates, screws and instruments described above, oneskilled in the art will appreciate that these described features can beused with a number of trauma treatment instruments and implants,including fixators, rods, and other plates and screws.

Although the invention has been described in example embodiments, thoseskilled in the art will appreciate that various modifications may bemade without departing from the spirit and scope of the invention. It istherefore to be understood that the inventions herein may be practicedother than as specifically described. Thus, the present embodimentsshould be considered in all respects as illustrative and notrestrictive. Accordingly, it is intended that such changes andmodifications fall within the scope of the present invention as definedby the claims appended hereto. The feature or features of one embodimentmay be wholly or partially incorporated into another embodiment withoutdeparting from the scope of the invention.

What is claimed is:
 1. A system for treating a fracture in a bonecomprising: a backpack; a bone plate configured to engage the bone, thebone plate comprising: an inferior end having a base portion extendingalong a first axis, the base portion comprising a first row of holes anda second row of holes for receiving one or more fasteners therein; and asuperior end having a shaft portion connected to the base portion, theshaft portion extending along a second axis, different from the firstaxis and comprising at least one additional hole for receiving afastener therein; at least one fastener received in the base portion andpositioned in the first row of holes or second row of holes; and atleast one additional fastener received in the shaft portion andpositioned in the at least one additional hole, wherein the backpack isconfigured to be temporarily attached to the base portion and configuredto provide a trajectory of insertion for the at least one fastenerreceived in the base portion.
 2. The system of claim 1, wherein thebackpack comprises a standoff.
 3. The system of claim 1, wherein thefirst row of holes is comprised of holes that are smaller than the atleast one additional hole.
 4. The system of claim 3, wherein thebackpack further comprises a reverse collet configured to attach thebackpack to the base portion.
 5. The system of claim 1, wherein the baseportion further comprises at least one suture hole.
 6. The system ofclaim 5, wherein the at least one suture hole is adapted to allow forthe insertion of a K-wire therethrough.
 7. The system of claim 1,wherein the shaft portion comprises an elongated dynamic compressionplating slot.
 8. The system of claim 7, wherein the dynamic compressionplating slot is at least twice a length of any of the other holes in thebone plate.
 9. The system of claim 1, wherein the shaft portioncomprises at least four holes.
 10. The system of claim 9, wherein the atleast four holes in the shaft portion include one or more compressionslots.
 11. A system for treating a fracture in a bone comprising: abackpack; a bone plate configured to engage the bone, the bone platecomprising: an inferior end having a base portion, the base portionhaving a first type of hole formed therethrough and a second type ofhole formed therethrough; and a superior end having a shaft portion, theshaft portion having a third type of hole formed therethrough and afourth type of hole formed therethrough; at least one fastener receivedin the base portion and positioned in the first type of hole, whereinthe at least one fastener is non-threaded; and at least one additionalfastener received in the shaft portion and positioned in the third typeof hole wherein the backpack is configured to be temporarily attached tothe base portion and configured to provide a trajectory of insertion forthe at least one fastener received in the base portion.
 12. The systemof claim 11, further comprising wherein the first type of holescomprises a first row of holes and a second row of holes for receivingone or more fasteners therein.
 13. The system of claim 11, wherein thebackpack comprises a standoff
 14. The system of claim 13, wherein thebackpack further comprises a reverse collet configured to attach thebackpack to the base portion.
 15. The system of claim 11, wherein thebase portion comprises at least one multi-functional hole adapted toreceive a K-wire or suture inserted therethrough.
 16. The system ofclaim 11, wherein the second type of hole is comprised of holes that aresmaller than the first type of hole.
 17. The system of claim 11, whereinthe shaft portion comprises an undercut contact surface.
 18. The systemof claim 11, wherein the shaft portion comprises a plurality of siderelief cuts.
 19. The system of claim 11, wherein the at least onefastener received in the shaft portion is threaded.
 20. A system fortreating a fracture in a bone comprising: a backpack; a bone plateconfigured to engage the bone, the bone plate comprising: an inferiorend having a base portion, the base portion having a first plurality ofholes formed therethrough; and a superior end having a shaft portion,the shaft portion having a second plurality of holes formedtherethrough, the shaft portion having an undercut contact surface and aplurality of side relief cuts formed therein between adjacent holes ofthe second plurality of holes; at least one fastener received in thebase portion and positioned one of the first plurality of holes; and atleast one fastener received in the shaft portion and positioned in oneof the second plurality of holes wherein the backpack is configured tobe temporarily attached to the base portion and configured to provide atrajectory of insertion for the at least one fastener received in thebase portion.